The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

Abstract

This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP’s roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.

The contribution of family physicians to African health systems

“…On average, patients waited for 9 months to be informed of their appointment date and 12 months for the actual appointment. 23 (Cape Town, South Africa)…”

“…The FPs would screen all referrals, which could significantly reduce the number of referrals. 23 (Cape Town, South Africa)…”

“…Improving coordination of care across the primary–secondary care interface requires building relationships of mutual respect and trust and overcoming ‘professional tribalism. 23 (Cape Town, South Africa)…”

“…These three interventions demonstrate clearly how FPs may use their understanding and clinical experience of the local burden of disease, system inequities, as well as available data to advocate for improved patient care access and coordination. 23 (Cape Town, South Africa)…”

“…A cross-sectional audit was conducted in the outpatient department during September 2017, which highlighted a significant problem for cardiac patients in accessing definitive care. 23 (Cape Town, South Africa)…”